Open the Airway

Once unresponsiveness has been determined, assistance obtained, and a defibrillator requested, the next step is to assess the upper airway of the victim. This usually requires positioning the individual supine on a flat, firm surface with arms along the sides of the body, followed by opening the person's airway. Unless trauma can be definitely excluded, any movement of the victim must take into account the potential of a spine injury; as the patient is placed supine, stabilize the cervical spine by maintaining the head, neck, and trunk in a straight line. If for some reason the patient cannot be placed supine, consider using the jaw-thrust maneuver (see below) from a lateral position to open the airway. Properly opening the airway is a critical and potentially lifesaving step. Common causes for airway obstruction in an unconscious patient are occlusion of the oropharynx by the tongue and laxity of the epiglottis. With loss of muscle tone, the tongue or the epiglottis can be forced back into the oropharynx on inspiration. This can create the effect of a one-way valve at the entrance to the trachea, leading to airway obstruction manifesting as inspiratory stridor. After positioning the patient, the mouth and oropharynx should be inspected for secretions or foreign objects. If secretions are present, they can be removed with the use of oropharyngeal suction; a foreign body may be dislodged by use of a finger sweep and then manually removed (see below).

Once the oropharynx has been cleared, two basic maneuvers for opening the airway may be tried to relieve upper airway obstruction. These are the head tilt-chin lift and the jaw thrust. These maneuvers help to open the airway by mechanically displacing the mandible and the attached tongue out of the oropharynx.

HEAD TILT-CHIN LIFT MANEUVER The head tilt-chin lift is usually the first maneuver attempted if there is no concern for cervical spine injury. The head tilt is performed by gently extending the neck. This is done by placing one hand under the patient's neck and the other on the forehead and extending the head in relation to the neck. This should place the patient's head in the "sniffing position" with the nose pointing up. In conjunction with the head tilt, the chin lift is performed. This is done by carefully placing the hand, which had been supporting the neck for the head tilt, under the symphysis of the mandible so as not to compress the soft tissues of the submental triangle and the base of the tongue. The mandible is then lifted forward and up until the teeth barely touch. This supports the jaw and helps tilt the head back.

JAW-THRUST MANEUVER The jaw thrust is the safest method for opening the airway if there is the possibility of cervical spine injury. It helps to maintain the cervical spine in a neutral position during resuscitation. The rescuer, who is positioned at the head of the patient, places the hands at the sides of the victim's face, grasps the mandible at its angle, and lifts the mandible forward ( Fig 8-1). The rescuer's elbows may rest on the surface on which the victim lies. This lifts the jaw and opens the airway with minimal head movement.

FIG. 8-1. Jaw-thrust maneuver.
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